The Irish Times
Recalling the “white death”
The recommendation to end a national policy of vaccinating all newborns against tuberculosis (TB), which has been in place since the 1950s, heralds a significant change to the Republic’s public health policy. For people of a certain age who remember the “white death” of TB and the effects on families and communities of what was a killer disease, it may seem questionable.
But science has spoken in the form of a comprehensive health technology assessment carried out by the Health Information and Quality Authority (Hiqa); it recommends a change to a policy of selective immunisation of children in high-risk groups using the Bacillus Calmette-Guérin (BCG) vaccine.
TB remains a global health challenge. An estimated 9 million people developed TB in 2013 and there were 1.5 million deaths from the disease. The incidence of TB in Ireland is similar to that of most other countries in the EU; we experience the same incidence as France, Belgium and Austria. However, only Ireland and Portugal have universal vaccination programmes despite neither being considered a high TB incidence country.
But the infectious disease has not gone away. Children remain vulnerable as occasional outbreaks in crèches and schools illustrate. Between 2005 and 2014, the average annual number of cases in children aged less than 15 years was 21. Of particular concern is the risk of TB meningitis in this age group.
The advantage of selective vaccination is that it would focus resources on those who are at higher risk of contracting TB. This includes infants born in, or whose parents are from, countries with a high rate of TB; those in contact with patients with active respiratory TB; and members of at risk groups in the community.
Some one-in-eight newborns will continue to be offered BCG should the Minister for Health implement the Hiqa recommendation. Potential budget savings must not sway his decision. Rather before doing so he must ensure that appropriate preventative and protective measures are put in place by the Health Service Executive.